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Research

Cochrane reviews compared with industry supported meta-analyses and other meta-analyses of the same drugs: systematic review

BMJ 2006; 333 doi: https://doi.org/10.1136/bmj.38973.444699.0B (Published 12 October 2006) Cite this as: BMJ 2006;333:782

Introduce Evidence Based Medicine into Medical Education Curriculum

Dear Editor,

Despite most reputable journals requesting for declaration of
interests from participants of research studies, it is still no surprise
that industry supported systematic reviews showed more bias than cochrane
reviews of the same drugs. (1). After all, he who pays the piper dictates
the tune. Even though in the hierarchy of evidence, a well conducted
systematic review of level I studies will provide the best evidence but,
if conducted without consideration for the limitation of bias, such review
could serve as a source of multiplicative errors from poorly designed
component trials. (2)

The main question therefore becomes how can we protect physicians
from being influenced by such reviews? Can we solely rely on regulatory
bodies? No. We believe the answer lies in arming every physician with the
tool to critically evaluate research studies. This can be done by
incorporating the tenets of critical appraisal and evidence based medicine
into medical education curriculum especially during postgraduate residency
training. The Royal College of Psychiatrists introduced this into its
membership examination curriculum in 1999. As far as we know, the
Department of Psychiatry, Drexel University College of Medicine in
Philadelphia is one of only a few residency programs that have evidence
based medicine as a core curriculum course during residency training in
USA. We believe that more training institutions as well as the individual
members of the American Board of Medical Specialties should introduce it
as a compulsory component of training and certification examinations.

Once physicians have this crucial ability to critically appraise
studies, they would be more adept at grading evidences as level I quality
or relegate it to level IV quality that is useful only if there is nothing
better in the database.

References

1) Jorgensen AW, Hilden J and Gotzsche PC: Cochrane reviews compared
with industry supported meta-analyses and other meta-analyses of the same
drugs: systematic review. BMJ, Oct 2006; 333: 7

2) Reviewing and Grading Evidence: The Guidelines manual. National
Institute for Health and Clinical Excellence: 2006, 49-190.

Competing interests:
None declared

Competing interests: No competing interests

30 November 2006
Babatunde Adetunji, MD, MA, MS, FASAM
Clinical Assistant Professor of Psychiatry & Co-Director of Evidence Based Medicine Course
Maju Mathews MD,MRCPsych: Director of Evidence based Medicine Course, Drexel University College of Medicine, Philadelphia. USA
Dept. of Psychiatry, Drexel University College of Medicine, Philadelphia. USA